| Summary: | 碩士 === 國立臺灣大學 === 醫學工程學研究所 === 99 === Background. Few studies have discussed the dynamic effects of spinal orthotic
intervention on patients with adolescent idiopathic scoliosis (AIS), nor have they
investigated the motion adaptation on them.
Objectives. The objectives of this study is three-fold: 1) To evaluate dynamic and
static balance between AIS patients and normal subjects; 2) to investigate the dynamic
and static balance effects of spinal orthotic intervention in the AIS patients during
investigative periods of immediate in-brace wearing and after four-month in-brace
treatment; 3) to evaluate the motion adaptation after four-month brace treatment in the
AIS patients.
Design. A prospective cohort study was performed for this investigation.
Participants. Fifteen adolescent females with AIS with Cobb angle of 20 to 50
degrees and fifteen age-matched healthy females participated in this study.
Interventions. The intervention treatment for the females with AIS was a
custom-made total contact thoracolumbar spinal orthosis.
Methods. The gait kinematic data and the standing centre of pressure (COP) data
were collected. For each AIS patient, data were collected for the following four
conditions—pre-brace, immediate in-brace, after four-month of brace treatment data
without the brace, and after four-month of brace treatment data in the brace. Normal
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subjects acted as the control and participated in gait analysis just one time.
Main outcome measures. The dynamic variables of temporal-distance parameters,
walking smoothness with harmonic ratios, and torsional offset of central segments
during gait were calculated. The static variables included COP sway, postural
orientation and head decompensation in static standing were also calculated for all
subjects and conditions.
Results. The walking smoothness measured by harmonic ratios was reduced in AIS
patients compared with healthy teenagers, especially in the vertical direction on the
head (p=.001), trunk (p=.001) and pelvis (p=.005) as well as the antero-posterior
direction on the segments of the head on pelvis (p=.025) and the trunk on pelvis (p=.01).
For the four-month effect of bracing, bracing negatively affected the smoothness in the
medio-lateral direction on the head (p=.001), in the global reference, but the smoothness
was not changed on the body reference in AIS patients. Moreover, the effect of
bracing restricted the pelvis motion during gait in the frontal plane causing the limited
motion on the trunk on pelvis. For the four-month motion adaptation, brace treatment
promoted the walking rhythm and smoothness in the vertical direction on the segment
of the head on pelvis (p=.026), but decreased in the medio-lateral direction on the head
(p=.018).
Conclusion. AIS patients before the brace treatment exhibited significantly poor
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walking symmetry compared with age-matched girls. AIS patients had abnormal
segmental offset during gait and abnormal segmental orientation in standing posture.
Bracing stiffened the range of motion on the body but did not disturb walking rhythm in
on the body reference in the four-month brace intervention. Brace treatment yielded
motion adaptation for walking rhythm in the body reference in the four-month brace
intervention.
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